Background

A commonly voiced concern is that health maintenance organizations (HMOs) may withhold or delay the provision of urgent, essential care, especially for vulnerable patients like the elderly.

Objective

To compare the quality of emergency care provided in Minnesota to elderly patients with acute myocardial infarction (AMI) who are covered by HMO vs fee-for-service (FFS) insurance.

Methods

We reviewed the medical records of 2304 elderly Medicare patients who were admitted with AMI to 20 urban community hospitals in Minnesota (representing 91% of beds in areas served by HMOs) from October 1992 through July 1993 and from July 1995 through April 1996.

Main Outcome Measures

Use of emergency transportation and treatment delay (>6 hours from symptom onset) ; time to electrocardiogram ; use of aspirin, thrombolytics, and bêta-blockers among eligible patients ; and time from hospital arrival to thrombolytic administration (door-to-needle time).

Results

Demographic characteristics, severity of symptoms, and comorbidity characteristics were almost identical among HMO (n=612) and FFS (n=1692) patients.

A cardiologist was involved as a consultant or the attending physician in the care of 80% of HMO patients and 82% of FFS patients (P=12).

The treatment delay, time to electrocardiogram, use of thrombolytic agents, and door-to-needle times were almost identical. (...)